Assisted Dying

Karin Smyth Excerpts

Monday 4th July 2022 Westminster Hall

[Tonia Antoniazzi]

I thank my right hon. Friend for his contribution, because that is often the case. Clearly, Gareth wanted people to know that he does not think what his dad did was actually suicide, but bringing an end to his suffering.

Susan’s husband, Duncan, was diagnosed with motor neurone disease, which we all know has no cure. Susan described Duncan as a very strong character who, after researching MND, determined straightaway that he was going to be in control of his own death. Until he had a plan in place, he was distressed and unhappy, but once he had a plan, he could start to live again. Three years after his diagnosis, Duncan took his own life at home with help from Susan. He left information for the police about how and why he had done it. Although his intention had been to do it when Susan was not at home, Susan said that, after 42 years of very happy marriage, she could not not be there for him at the end.

Despite the information that Duncan left, it was six months before the Crown Prosecution Service deemed that it was not in the public interest to prosecute Susan. She was interviewed for six hours under caution by the police, which, after the death of her husband, was obviously very distressing. I cannot imagine how it must feel to have something like that hanging over you when you should be grieving the loss of a loved one. Susan had the means to fight these charges and her solicitor eventually got her arrest removed from her record. What happens to someone who does not have the money to stand up to a criminal justice system that demonises people who find themselves in this invidious position?

Susan also believes that because Duncan made his intentions clear, the doctor seemed reluctant to give him drugs to help him sleep, which exacerbated his problems. Ultimately, Susan takes comfort in the fact that Duncan got the death he wanted. However, it is a tragedy that his death was not within the law. We know that people falling foul of the criminal justice system is not uncommon in situations where someone ends their life, but empathy and sensitivity are required in these situations—not the heavy-handed approach we have seen too often.

Tim was a carer to his friend, David, who also had motor neurone disease. Within two days of his diagnosis, David had signed up to Dignitas. It was more than two and a half years before he died, after travelling to Switzerland. There is only one end to a diagnosis of MND, and David was not willing to be trapped in his body while his brain was still functioning. By making the decision to join Dignitas, David had some peace of mind. However, even with his membership, the process was not always easy; information was not forthcoming until certain points in David’s illness, and the full picture was not available until they reached Switzerland.

It would have been so much easier if David could have done it at home. At home, the only option David was given was to be sedated for three weeks while his body shut down—as Tim said, prolonging the suffering. When Tim spoke about the inevitability of David’s death, he said that doctors were willing to prolong his life to the extent where the consequences were not worth it. Pain was not really an issue for David, but the suffering that he went through—not being able to sleep due to choking; having to be fed through a tube in his stomach—was unbearable.

Throughout this process, all participants have spoken of the anxiety that they faced because they or their loved ones did not have the option of assisted dying. As Jan said in her contribution, knowing that there is an option for assisted dying is an insurance policy: it may not be something you decide to do in the end, but having it there is a comfort. We have to consider the impact on the families who are left behind. Having to watch a loved one die is never easy, but prolonging the suffering can lead to trauma and PTSD for families and friends. I have already spoken on the record about my father dying.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is representing the Petitions Committee superbly and speaks on behalf of the families we have met outside.

I think we all appreciate how difficult it is for people to come to us to talk about personal experiences. My hon. Friend has spoken about her father before. I know he would be very proud of her. We all know how strong her support is for this cause.

[Tonia Antoniazzi]

I thank my hon. Friend for that intervention to save me from a few more tears. I wanted to say that the PTSD my brother suffers as a result of my father dying is something we will all have to live with as a family. I think that is worth mentioning.

Tim said that palliative care can mitigate some of the pain, but it can never mitigate the suffering. This seems to be so true. Even the best palliative care cannot make it easy, and it never is going to be easy, but we could do a lot more to make it better. Research has shown that where assisted dying is an option, palliative care improves. I truly believe that everyone in this debate can get behind that. We must do better for those at the end of their life.

I am also grateful to Liz Carr for taking the time to speak to me on Friday evening. The worries that Liz and other campaigners have need to be heard, and I believe we have a duty as Members of Parliament to open up this debate and listen to all sides. There are so many debates where people are very polarised in their arguments, particularly in this House, and I feel very strongly that both sides should be heard and that we should listen to everyone.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger, and to follow my fellow chair of the all-party parliamentary group on choice at the end of life, the right hon. Member for Sutton Coldfield (Mr Mitchell).

I am not a convert. I have wanted to change the law on assisted dying since I became a Member of Parliament, following my experience 14 years ago working with clinicians on how to communicate with patients about how to live and die with respiratory disease. That is not terminal, but the work opened my eyes to how we talk about death—how we do not prepare for the inevitable and, although we seek to have choice, agency and freedom throughout our lives, we have no power at the end. There will be many people listening to the debate who are facing death or the death of their loved ones. As we debate this issue, we must be mindful of the personal circumstances and experiences of those people, and of all of us in the Chamber.

End-of-life care has improved since my work in the health service 14 years ago, but there is still a contrast between how we talk about dying and how we attempt to talk about other care, which is indicative of the problem. In all my years working in the planning and commissioning of services in the NHS, it was all about co-production—the importance of patient voice and choice—but the co-production partnership disappears at the time we can least fight: the time we die. However, the reality is that a person can have choice—if they have an average of £12,000 spare. We can debate all we like, we can pretend this is not an issue, and the Government can turn an eye, but if a person has the money, they have the choice.

For campaigners, that is a really frustrating position. As we have heard, poll after poll suggests that we as MPs are far from our constituents on this issue. I have been humbled today by meeting families and friends who have travelled to speak to us and share their stories. It is absolutely right that, if Members of Parliament have not previously engaged with this subject, they should engage with it, they should be properly informed, and they should have the opportunity to scrutinise all the proposals and to be convinced that change is better and safer than what we have now. We seek parliamentary time to do just that.

First, we must understand that the current situation is not safe or sustainable. Secondly, we want to learn from those who have safely operated an assisted dying law for over 20 years. Thirdly, we want to ensure that we address all the concerns expressed, especially about safeguarding.

We have heard some shocking examples of people taking their own lives. My hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke movingly about that three years ago, and we see it in the ONS data. Currently, there are no up-front safeguards to stop people taking their own life or refusing food, water or ventilation. There is no regulation on people choosing not to have treatment. People live in fear of accompanying their loved one and getting that knock on the door from the police—that happens. Additionally, as I said, there is choice for those who can afford it.

We need to scrutinise the proposals and learn from Oregon and from recent debates in Australia and New Zealand. Since we last debated the subject, as the right hon. Member for Sutton Coldfield said, six states in Australia have legalised assisted dying, as have several states in the United States, New Zealand, Canada and many other countries. I have had the pleasure of talking with parliamentarians from across those countries about the debates they have had. We can learn from them. The concerns raised by opponents have not come to pass. Medical opinion has shifted dramatically, and new evidence has been published that demonstrates how unsafe our current law is. That is why I am confident in these proposals.

We need time to go through the arguments and the safeguarding concerns. I have spoken to several MP colleagues and I understand those concerns, but they have not come to pass elsewhere. The rights of people in different parts of the United Kingdom are dominating our politics. In fact, in the main Chamber, Members are currently talking about Northern Ireland as part of the United Kingdom. With proposals coming through in Jersey and Scotland, the United Kingdom Parliament and the United Kingdom Government will have to engage with assisted dying here in the United Kingdom. It is useful to have debates like this one, but what we need is Government time. I hope the Minister will take the Government’s head out of the sand and respond positively to the request for just that.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

I pay tribute to the 155,000 people who signed the petition prompting today’s debate and to my hon. Friend the Member for Gower (Tonia Antoniazzi) for the way she introduced it.

It is an extraordinary coincidence, but today is the 11th anniversary of my father’s death—more extraordinary, because the last time the Commons debated assisted dying on the Floor of the House was the eighth anniversary of his death. Like an estimated 300 people in the UK every year, he took his life after a terminal diagnosis. Although I still find it difficult to talk about, I want to share his story today, because he would have wanted me to, and because his experience echoes that of so many others and informs a central issue in our discussion. Inevitably, the debate on providing choice at the end of life often focuses on the impact of the change that is being proposed, but I think we should start from a different place: by looking at the existing law and recognising the pain it causes, and the way it forces so many into desperate and premature deaths.

Eleven years ago today—also a Monday—I got a phone call here: he had been found dead in his garage. I had spoken to him the previous night on the phone as I walked through St James’s Park. An ordinary conversation that gave me no inkling of his plan. But later he obviously tidied up his belongings, left some small piles of money to settle bills with—with the newsagent and one or two others—and wrote some final notes. He then walked to the garage, connected a hosepipe from his car exhaust into the car, took an overdose and switched on the engine.

I was shocked and clearly still struggle with it, but I should not have been surprised, because he had always believed that the law should be changed to allow assisted dying. And let us be clear—we should be very clear about the terms we use—my dad was not suicidal. He loved life; he was 87. But at that age he had inevitably watched many of his friends go, often miserably—horrific deaths. He talked with me about their last days and he had always been clear that he would rather end things than face a lingering and degrading death, but I still was not expecting it.

He was somebody who had made the most of life. He had a tough east-end upbringing, became an RAF pilot during the war and built a successful business career. He had had his share of health problems, but he faced them all positively, until a terminal diagnosis of inoperable lung cancer clearly led to his decision to take his life. He could not talk to me or his partner about it, because he would have made us complicit. The current law forced my father into a lonely decision and a lonely death. And he died prematurely, because I am sure that what drove him to end his life at that point was the fear that if he did not act when he was still able to do so, he would lose the opportunity to act at all.

[Karin Smyth]

My hon. Friend is making a very powerful speech. I am grateful to him for sharing his story with us again. What he exemplifies is the wider impact on the family. Families are loving places to be for most people, and the impact goes on for a number of years. The inability to have those conversations with family is one of the things that my hon. Friend is highlighting for us today. The current law inhibits honest conversations in families to help a more supportive situation to go forward. I think that is something we should all take with us this afternoon.

[Paul Blomfield]

I thank my hon. Friend for that intervention. She is absolutely right, and I appreciate the breathing space that she has given me.

Some people have already said in this debate that we simply need to improve end-of-life care. We should, and I say to the hon. Member for Devizes (Danny Kruger), contrary to his comments, that many of those states, for example in Australia, that have introduced assisted dying have, at exactly the same time, substantially increased the amount of money spent on palliative care. We should do that, but it would not have changed my dad’s decision. He supported our local hospice. I have raised funds for it. It does a great job. But no hospice can enable everybody to die with the dignity that they would want.

Indeed, for my father, it was soon after his appointment with the palliative care nurse, where together they talked about his last months and how that would pan out, that he took the decision to end his life. My hon. Friend the Member for Bristol South (Karin Smyth) alluded to the fact that, if the law had made it possible, he could have shared his plans with us. And knowing that he could, with support, go at the time of his choosing would have enabled him to stay longer. If the law had made it possible, he would have been able to say goodbye and go with his family around him, not in a carbon monoxide-filled garage. He deserved better and many others like him deserve better. And we, here, can make that possible. We simply need to change the law, as the overwhelming majority of the British people want.

I appreciate that there are those whose personal belief makes my father’s choice unacceptable. I respect those beliefs. Live your life by them. But do not impose them on others. Let people have the choice at the end of their lives. Allow them the dignity in dying that we would want to give them during their life.

Domestic Abuse Bill

Karin Smyth Excerpts

2nd reading & 2nd reading: House of Commons
Tuesday 28th April 2020 Commons Chamber

[Karin Smyth (Bristol South) (Lab) [V]]

I, too, welcome this long overdue Bill and many of its provisions. Since becoming the Member for Bristol South in 2015, the impact of domestic violence has been one of the most heartbreaking and dominant parts of my casework. My surgeries have been filled with women, mainly in their 20s, with children, who have been desperate to remain part of their community and have had family support but who have been seeking refuge from their perpetrator. The impact is wide, and when in recent discussions with headteachers and local police we have been trying to identify behavioural problems locally, we have often come back to a background of young men experiencing violence at home and then repeating it.

This Bill is crucial for many of my constituents, because our area has some of the highest rates in the city. In 2018-19, police figures for Bristol showed more than 10,000 domestic violence and abuse incidents, but there is a shocking disparity between levels of violence across the city. A 2017 report on women’s health showed that the rate of domestic violence against women in some wards in my constituency was double the national average. There has been a problem for some time, and one that I raised with the UN rapporteur on human rights in 2018. In some of our communities it is embedded, normalised and long-term, and often not discussed. A significant part of the problem is that cases are not reported, which presents huge difficulties for people supporting the victims. Some 14% of the population in one of our wards think that abuse is a private matter—compared with a figure of 7% across Bristol as a whole. Sometimes a reluctance to speak out against abuse is related to the amount of time it has been going on. A report by the south-west rape crisis centre partnership entitled “The chilling silence” identified sexual abuse among older women in particular, and often not much publicity is given to those women. I would like to see that issue addressed in this Bill.

In February, I held a surgery especially for women who had come through domestic violence—they were largely on the other side—and I asked them what services they would like to see changed. I am grateful to them for sharing their experiences and being brave. Most of the suggested changes centred on the justice system, but many related to mental health support once a victim has managed to flee their abuse, because the trauma does not end when someone leaves. I heard many examples of how the state apparatus is then used to manipulate the victim from a distance; for example, childcare arrangements and child maintenance payments can all add to the psychological trauma once someone has left.

I wish to focus my comments on part 4 of the Bill. Bristol City Council is doing some excellent work in this area, alongside some brilliant partner organisations, but I am deeply concerned that the duty placed on local authorities to support and protect victims is not sustainable without the Government providing the necessary funding. After the past 10 years of cuts locally, this is an unrealistic ask, and funding must accompany duty and responsibility. Housing is also key. Having enough accessible and appropriate housing to accommodate victims quickly is essential, but far too often I have seen women and their children forced to move out of local areas, away from support networks and their families, while the perpetrator remains in the house. Where it is safe and appropriate to effect change, I hope that measures will be taken forward in this Bill.

The Justice Secretary, in his opening remarks, identified a complex landscape locally, and the role of local authorities and police and crime commissioners. He said that the new commissioner would seek to understand that. I hope that she works closely with those in Bristol, as people there are doing a remarkable job. I wish to highlight the work being done by Avon and Somerset police, and I pay tribute to the police and crime commissioner, Sue Mountstevens, who over eight years has led tremendous work in this area, working with voluntary organisations.

The police could not do such work without our excellent voluntary sector’s work with victims. The sector is coming particularly to the fore at this time, doing tremendous work to support women locally. However, if the Government are really serious about making an impact, they should support the call from my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) for a duty to provide funding for this work, and particularly to ensure that good, quality-assured perpetrator programmes are in place.

Terrorist Offenders (Restriction of Early Release) Bill

Karin Smyth Excerpts

2nd reading & 2nd reading: House of Commons
Wednesday 12th February 2020 Commons Chamber

[Nick Thomas-Symonds]

My hon. Friend speaks with great authority about HMP Birmingham, and he is right to identify that if prisons are run in such a way there will be consequences because the time available for meaningful activity is reduced.

The Justice Secretary talked in the media at the weekend about improvements in our justice system since Mr Acheson’s report. He repeated that in his speech and he has repeated it in an intervention a moment or two ago. I therefore thought I would compare what the Justice Secretary is saying with the views of the independent chief inspector of prisons. The latest annual report from Peter Clarke states that

“far too many of our jails have been plagued by drugs, violence, appalling living conditions and a lack of access to meaningful rehabilitative activity.”

That should be a wake-up call to the Government. Mr Clarke went on to say that

“levels of self-harm were disturbingly high and self-inflicted deaths tragically increased by nearly one-fifth on the previous year.”

That is no way for the Prison Service to be run and things must change.

There is also, if I may say so, an issue at the Ministry of Justice with the Government failing to provide it with stable leadership. The right hon. and learned Gentleman is the seventh Justice Secretary since 2010. Of those seven, five have served for 18 months or less. The role of Lord Chancellor should have been respected and not been subject to a revolving door. No wonder there is such a lack of direction and no wonder there is no long-term planning. Justice Secretaries are simply not in post long enough. There are even indications from 10 Downing Street that half the Cabinet could be out by Friday.

I say in all sincerity to the right hon. and learned Gentleman that I very much hope he survives in this role—I hope I have not jinxed him by saying that; I could have just ruined his Friday—because there is an enormous job to do. There are 224 terrorist prisoners in England and Wales, of whom 173 have been assessed as having extreme Islamist views. We also know that there is a growing threat from far-right terrorism. If we want properly to manage the risk of terrorist offenders, we need the most effective targeted de-radicalisation programmes to be delivered by staff working in the best conditions we can provide for them.

[Karin Smyth (Bristol South) (Lab)]

One area has not been mentioned. When I took part in the police service parliamentary scheme and spent some time with the counter-terrorism units, the one area they highlighted was working on the ground with mental health resources in our communities. That risk decision, the decision at community level about someone’s mental capacity and radicalisation, is really important when we look at resources. The cuts to our mental health services are having an impact on this area.

[Nick Thomas-Symonds]

My hon. Friend is absolutely right. I think we sometimes see things in isolation, but cuts to many other services have also had an impact, which the Government need to take into account. Indeed, when we talk about conditions for our prison officers to work in, a third of our prisons were built in the Victoria era. There is a £900 million maintenance backlog and a desperate need for new investment.

Assisted Dying

Karin Smyth Excerpts

Thursday 4th July 2019 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Ten years ago, I worked with some excellent doctors, nurses, patients and carers who were trying to improve clinicians’ communication skills to help patients gain a better understanding of long-term conditions and diseases—how to live with their disease and how to die with it. As my hon. Friend the Member for Gower (Tonia Antoniazzi) said, not all clinicians are equipped with the skills necessary to have those conversations. I learned particularly about how lonely it is for people who are dying—it is often nobody’s role to talk about dying—and no one has exemplified that today more than my hon. Friend the Member for Sheffield Central (Paul Blomfield). It is a very lonely place. I learned that people do not have the control and choice that they otherwise have in their lives, and I learned how hard is for clinicians to support people. It really opened my eyes and made me determined to change the law even before I came into this place.

It is a pleasure to work with the hon. Member for Grantham and Stamford (Nick Boles) as co-chair of the all-party group. In that capacity, it was my absolute pleasure to welcome and host Geoffrey and Ann Whaley when they came to talk to MPs in February. I welcome Ann to the Chamber, as well as all the other families who have come here to listen to this very measured debate.

When the campaigners, who are very passionate on this subject, come to see me, I talk to them about how to talk to their own MPs, and the first thing I say to them is, “Try to look at the MP in front of you as a human being.” We know in this place and in this time in our politics that lots of people do not think we are human beings, and it is difficult, but we are human beings. I say to those campaigners, “You do not know what those human beings you are talking to have experienced in their lives or are currently experiencing in their lives. Please bear that in mind when you start to talk to us.”

We are here as human beings, but we are also here as legislators, and legislation is what we are trying to encourage with this debate. Through the all-party group, we are trying to help all of us human beings, with all our failings, prejudices and experiences, to understand the law as it operates, how it affects people and what we need to do to take our responsibility to change that. I am clear that the law needs to change, but I understand that many people have not got to that place. We want to try to help people. In particular, we want to try to get evidence. The call is not just to trade facts and figures, but to collect evidence. I really hope that we can help to move forward on that today.

The story of Geoffrey and Ann really did horrify me, although it is not the first time I have heard it. We have two committed, loving people being treated as criminals for carrying out what was an act of love and compassion. We should also think about the impact on people like those in our police services. Think about the poor police officers who were sent round as this lovely family were trying to manage a terrible situation. Think about the time taken out of their duties and the trauma for them as individuals. That is not acceptable; it is us abrogating our responsibility.

Geoffrey died comfortably at Dignitas only a week after he came to Parliament. He was clear that he was dying before he was ready, and he was terrified about the police investigation. As the hon. Member for Grantham and Stamford said, he was a strong man. When he talked to us, the only time his voice faltered was when he talked about that knock on the door, because he was so worried about the impact on his family. He was clear about the hurdles that needed to be jumped to make the decision that he wanted to make, but he was also clear that he did not expect MPs just to change the law. He had high standards for us as MPs. He expected us to collect evidence and to challenge the evidence, and to do so very carefully. He was, as the hon. Gentleman said, cut from some old cloth. He expected us to do a diligent job.

[Bob Stewart]

It seems to me that the law is grossly unfair. If someone has the resources—we have talked about £10,000—they can go to an alien place and die, with a few family around, and their body can be brought back. But they have to have the money to do it. Currently, our law is not fair, because it differentiates between people who have the resources to end their life when they want to, without the pain and the indignity, and those who cannot afford it, who are the vast majority. That is wrong, and that is where the law has to change.

[Karin Smyth]

I am grateful to the hon. Gentleman for his intervention. He must have seen the next point in my speech, because it is exactly that. Geoffrey and Ann’s story has been the prompt for this debate, but they are not the only family to go through this process. More than 400 Britons have died at Dignitas, and one Briton is dying in Switzerland every eight days. Every person who dies leaves behind a loved one facing the risk of prosecution. He is absolutely right: they have parted with more than £10,000. The family were very open with us that they could afford that, but most of my constituents in Bristol South absolutely cannot afford anywhere near that sort of money. This is a cross-party debate, and people have their individual views, but for me, as a socialist, it is eminently wrong that people who have resources can have that choice and those who do not cannot. That is one of the many reasons why I think we need to change.

The vast majority of people in this country who are dying of a terminal illness can expect a comfortable, dignified and pain-free life. The palliative care service is amazing, and I have worked with many clinicians over time, but they cannot alleviate all symptoms.

I just want to add that a third of patients in Oregon who request assisted dying do not use it. The autonomy that is granted by the choice is very comforting. Autonomy, choice and dignity are important. We must do better with our laws. Our law is outdated, unpopular and uncompassionate. It is time to look at the undue suffering that the blanket ban on assisted dying is causing people at the end of their life, because compassion is not a crime.

Children’s Funeral Fund

Karin Smyth Excerpts

Wednesday 1st May 2019 Commons Chamber

[Edward Argar]

I am grateful to my right hon. Friend for updating the House on that.

[Karin Smyth (Bristol South) (Lab)]

I pay tribute to my hon. Friend the Member for Swansea East and others involved in this. What we are hearing from the Minister about how government works across England is really alarming. The fact that the Prime Minister driving a policy change is so complicated in England, whereas our friends and colleagues across the United Kingdom can make these decisions more quickly, is a lesson for Government in how England is represented in this place. I hope that lessons about the complexities through which the Minister has had to drive this will be learned for other policy areas.

[Edward Argar]

I am grateful to the hon. Lady, but I would say to her that, as I mentioned earlier, we are not seeking simply to replicate what has been done by the devolved Administrations. We are looking at other aspects and seeing whether there are ways in which we might go a bit further. That does add complexity, so it is not exactly replicating something that is already there. However, she makes her point, as ever, courteously but forcefully.

Assisted Dying (No. 2) Bill

Karin Smyth Excerpts

Friday 11th September 2015 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

We all come to the House in our different capacities today, and we have heard some emotional and impressive personal experiences. Our purpose here is as legislators, and as such we cannot continue to turn a blind eye to a situation where people with financial resources can make a choice about how and when they die, and travel to Switzerland, while those without resources cannot. My view has been profoundly influenced by my work as a manager in the national health service. A few years ago I worked on a project with some excellent doctors and nurses who were trying to build, improve and develop their communication skills and those of patients, in order to talk about and get a better understanding of respiratory disease. They were committed to helping patients understand how to live with their disease, and eventually how to die with it.

I learned a huge amount, especially from patients, particularly about how poorly equipped they were to talk about how to die with dignity, and how lonely it becomes when it is nobody’s role to talk to them about dying. That insight into how little choice and control patients have, as well as the minefield being navigated by our clinicians, opened my eyes to the need for society to open this debate and acknowledge that death is a part of life. We need to end the taboo that surrounds death in our society. It also highlighted to me the need to be more open about how we respond with compassion to the knowledge of imminent and inevitable death.

In subsequent work I have done on end-of-life and palliative care services, I became more aware of the huge variability of service provision. Supporters of the Bill are not opponents of palliative care. In my parliamentary career, I will continue to work for better awareness of the need to talk about death and dying, and for better palliative care and end-of-life services. I am delighted to hear so many Members today speak about the need for better palliative care services, but at a time—this is not a party political point—when we know there will be £22 billion of cuts in our health services, I worry that that is not going to be possible in the next five years.

People who wish to choose the time of their death can do so now, but must rely on Switzerland to manage the consequences. It cannot be right that some of my constituents can afford to go to Switzerland, but the majority cannot. I respect and understand people who are worried about vulnerability, old age and disability, and I respect the concerns about safeguards, but we do deal with many similar issues. As the hon. Member for Reigate (Crispin Blunt) said, many of them would, and should, be considered in Committee. I also respect the reluctance to make what feels like a big decision to take a leap into a new area, but the Rubicon has been crossed, the train has already left the station and Parliament cannot keep turning a blind eye. Our purpose is to establish the principle that terminally ill people can be afforded choice and dignity.